1. The Role of LHDs in Improving Population Health LaQuandra S. Nesbitt, MD, MPH Director, LMPHW KHDA Retreat October 9, 2013

2. Agenda Improving “health” Work of “public health” Improving “population health” Role of LHDs How to transition Discussion

3. IMPROVING HEALTH

4. What is Health? “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” World Health Organization

5. What Determines the Population Health Status? Policies & Programs 50% =

6. How Do We Improve Health?

7. THE “WORK” OF PUBLIC HEALTH

8. What is Public Health “Public health is the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals” World Health Organization

9. Core Functions of Public Health Food Hygiene, Public Facilities, Wastewater, Pools, Onsite Sewage, Smoke Free Ordinance LMPHW Clinics (Family Planning, Immunization, STD, Tuberculosis) Obstetrical Ultrasounds Breast, Colorectal & Cervical Cancer Screening Family Health Center Quality Charitable Care Trust Student Practicum Opportunities Training (CEUs) for staff Evolving Partnership with U of L Annual Performance Planning Results Framework Vital Statistics Analysis Behavioral Risk Factor Surveillance System (BRFSS) EPSDT Communicable Disease Investigation Epidemiology Site Assessments & Education Public Health Laboratory Diabetes, Heart Disease Nutrition (incl. WIC) & Physical Activity Medicare Fraud Maternal & Infant Home Visitation Center for Health Equity Mayor’s Healthy Hometown Movement (Community Transformation Grant) Mayor’s Healthy Hometown Movement Leadership Team Health Impact Assessments

10. Where Does the Money Come From?

11. All Funding Sources Combined

12. IMPROVING POPULATION HEALTH

13. What is Population Health? “Population health is the health outcomes of a group of individuals, including the distribution of such outcomes within the group” Kindig D, Stoddart G. What is population health? American Journal of Public Health 2003 Mar;93(3):380-3

14. Improving Population Health Health care goal – The improvement of individual patient outcomes through the provision of medical services Public health goal – Improving health outcomes in the population as a whole through health promotion and disease prevention Hardcastle et al. “Improving the Population’s Health: The Affordable Care Act and the Importance of Integration” Journal of Law, Medicine and Ethics Fall 2011

15. Improving Population Health Recognize the impact of the social determinants of health Collect population level data and use it to make program and policy decisions Close the chasm between public health and clinical medicine

16. Why Integration? Policy decisions may have unintended consequences Improves quality of care for patients Avoids duplication and the resulting unnecessary costs Public health and individual health care complement, but cannot replace, each other Hardcastle et al. “Improving the Population’s Health: The Affordable Care Act and the Importance of Integration” Journal of Law, Medicine and Ethics Fall 2011

17. LHD’S AND POPULATION HEALTH

18. Role of Local Health Department Convener Data collection and analysis Establish priorities Subject matter expert(s) for community Research/review best practices Advocate for local and state policy

19. Louisville Metro Example Issue: Current safety net funding levels are unsustainable – Convene “safety net” organization leaders – Identify high utilizer/cost patterns – What worked in Cincinnati, OH and Camden, NJ – Participate in policy discussions regarding system reform

20. Louisville Metro Example Issue: Local hospital needs to decrease readmissions – Identify which patients are being readmitted more frequently – Draw on strengths of hospital (nurse case management/discharge planning) and local health department (community health worker/home visitation) – Collect data and determine effectiveness of intervention – Disseminate findings

21. HOW TO TRANSITION

22. Introspection Do I have the right staff? Are we allocating resources appropriately? Does our board of health have the right composition? Do members of my community recognize me as a leader? Am I prepared to get out of the business of healthcare?

23. Introspection Does my team realize the field of public health is evolving? Is maintaining the current FTE levels in my organization a priority? Do I have a plan to teach my staff new skills?

24. Contact Info LaQuandra S. Nesbitt, Director, LMPHW laquandra.nesbitt@louisvilleky.gov @DrLNesbitt